, Volume 22, Issue 13, pp 857–876 | Cite as

A Decision Chart for Assessing and Improving the Transferability of Economic Evaluation Results Between Countries

  • Robert WelteEmail author
  • Talitha Feenstra
  • Hans Jager
  • Reiner Leidl
Original Research Article


Objective: To develop a user-friendly tool for managing the transfer of economic evaluation results.

Methods: Factors that may influence the transfer of health economic study results were systematically identified and the way they impact on transferability was investigated. A transferability decision chart was developed that includes: knock out criteria; a checklist based on the transferability factors; and methods for improving transferability and for assessing the uncertainty of transferred results. This approach was tested on various international cost-effectiveness studies in the areas of interventional cardiology, vaccination and screening.

Results: The transfer of study results is possible pending the outcomes of the transferability check and necessary adjustments. Transferability factors can be grouped into areas of methodological, healthcare system and population characteristics. Different levels of effort are required for analysis of factors, ranging from very low (e.g. discount rate) to very high (e.g. practice variation). The impact of differences of most transferability factors can be estimated via the key health economic determinants: capacity utilisation, effectiveness, productivity loss and returns to scale.

Depending on the outcomes of the transferability check a correction of the study results for inflation and for differences related to currencies or purchasing power might be sufficient. Otherwise, modelling-based adjustments might be necessary, requiring the (re-)building and sometimes structural modification of the study model. For determination of the most essential adjustments, a univariate sensitivity analysis seems appropriate. If not all relevant study parameters can be substituted with country-specific ones, multivariate or probabilistic sensitivity analysis seems to be a promising way to quantify the uncertainty associated with a transfer. If study results cannot be transferred, the transfer of study models or designs should be investigated as this can significantly save time when conducting a new study.

Conclusions: Our transferability decision chart is a transparent and user-friendly tool for assessing and improving the transferability of economic evaluation results. A state of the art description of the methodology in a study, providing detailed components for calculation, is not only essential for determining its transferability but also for improving it via modelling adjustments.


Economic Evaluation Modelling Adjustment Transferability Factor Study Country Practice Variation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors have advised there was no external funding to support this study and therefore, the authors have no conflicts of interest that are directly relevant to the content of this study.


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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Robert Welte
    • 1
    • 2
    Email author
  • Talitha Feenstra
    • 2
  • Hans Jager
    • 2
  • Reiner Leidl
    • 1
  1. 1.Institute of Health Economics and Health Care Management (IGM)GSF National Research Center for Environment and HealthNeuherbergGermany
  2. 2.Centre for Prevention and Health Services ResearchNational Institute of Public Health and the EnvironmentBilthovenThe Netherlands

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